Introduction

Use of penile sparing surgery (PSS) for penile carcinoma (PC) has been well characterized for low stages of the disease. In this present study we analyzed the outcomes of patients treated with circumcision, partial/total glansectomy, laser ablation, or wide local excision (WLE) for primary PC.

Methods

We included 1260 consecutive patients who underwent PSS at 5 academic institutions from July 2000 to June 2015. Tumor and patient characteristics such as age, tumor size (cm), tumor grade and pathological stage were recorded and analyzed. Kaplan-Meier analysis was performed to evaluate 1 year, 2 year and 5 year recurrence free survival (RFS) among the groups. Multivariable Cox proportional hazards regression was used to assess prognostic factors for RFS and overall survival (OS).

Results

Glansectomy patients had higher size, grade and pathologic stage tumors at time of surgery (p < 0.05). At a median follow up of 39.9 months, 37.1 % of patients treated with laser ablation had a local recurrence vs. those who underwent glansectomy or WLE alone (7.6 and 19.5%, respectively; p < 0.001). Patients who had laser procedures also had worse 1-yr, 2-yr and 5-yr RFS (74.4, 65.1 and 51%) vs. glansectomy (81.2, 72.4 and 68.8%, respectively) or WLE (80.3, 66.7 and 55.4%, respectively) (p = 0.056). Mutlivariable analysis found tumor grade (HR = 1.5, p <0.001) and corporal invasion (HR = 1.4, p = 0.05) to be significant, independent predictors for disease recurrence. Age was a significant prognosticator for OS (HR = 1.1, p < 0.001).

Conclusions

Tumor grade and corporal invasion were found as independent predictors of disease recurrence after penile sparing treatments. Patients treated with laser ablative techniques had worse recurrence outcomes. Strict surveillance guidelines for these patients are greatly needed.

Funding

none